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After completing this lesson, you should be able to:
3-1 Given information about a simulated casualty,
determine what should be done to open or maintain the casualty's airway.
3-2. Identify the procedures for performing a head-tilt/chin-lift.
3-3. Identify the procedures for performing a jaw thrust.
3-4. Identify the procedures for performing rescue breathing.
3-5. Identify the procedure for inserting a nasopharyngeal airway.
3-6. Identify the procedures for removing an obstruction from a casualty's
airway.
3-7. Identify the procedures for performing cardiopulmonary resuscitation.
REFERENCES
STP 21-1-SMCT, Soldier's Manual of Common Tasks: Skill
Level 1.
FM 4-25.11, First Aid.
Training Support Package 071-D-2317 / First Aid 2 (Manage the Airway)
Training Support Package 071-D-2323 / First Aid 8 (Perform Cardiopulmonary
Resuscitation-CPR)
LESSON 3
OPENING AND MANAGING A CASUALTY'S AIRWAY
Section I. ON THE BATTLEFIELD
3-1. MOVING TO SAFETY
If a casualty is not breathing, you must take measures to
restore respiration (breathing) as soon as possible. If you are under enemy
fire, quickly move yourself and the casualty to a location where you can
safely administer measures to restore breathing. (See Lessons 1 and 2.)
3-2. CHECKING THE CASUALTY FOR RESPONSIVENESS
If the casualty appears to be unconscious, check the
casualty for responsiveness. Ask in a loud, but calm, voice: "Are you okay?"
Also, gently shake or tap the casualty on the shoulder. If the casualty does
not respond, open his airway.
3-3. POSITIONING THE CASUALTY
If the casualty is not on his back, turn him onto his back
using the procedures given in paragraph 2-5 of Lesson 2.
3-4. OPENING THE CASUALTY'S AIRWAY
When a casualty becomes unconscious, all of his muscles
may relax. This relaxation may cause the casualty's tongue to slip to the
back of his mouth and cover the opening to his trachea (windpipe). Removing
the obstruction and opening the airway may allow the casualty to resume
breathing on his own. Two approved methods of opening the casualty's airway
are the head-tilt/chin-lift method and the jaw thrust method. If you suspect
that the casualty has suffered a neck or spinal injury, use the jaw thrust
method. Otherwise, use the head-tilt/chin-lift method.
NOTE: Even if the
casualty is still breathing, positioning the airway will allow him to
breathe easier.
NOTE: If you see
something in the casualty's mouth (foreign material, loose teeth, dentures,
facial bone, vomitus, etc.) that could block his airway, use your fingers to
remove the material as quickly as possible.
a. Head-Tilt/Chin-Lift Method.
CAUTION: Do not use this
method if a spinal or neck injury is suspected.
(1) Kneel at the level of the casualty’s shoulders.
(2) Place one of your hands on the casualty’s forehead and apply firm, backward pressure with the palm of your hand to tilt the head back.
(3) Place the fingertips of your other hand under the tip of the bony part of the casualty’s lower jaw and bring the chin forward. See figure 3-1.
(4) Lift the chin forward until the upper and lower teeth are almost brought together. The mouth should not be closed as this could interfere with breathing if the nasal passages are blocked or damaged. If needed, the thumb may be used to depress the casualty's lower lip slightly to keep his mouth open.
Figure 3-1. Opening the airway using the head-tile/chin-lift method.
CAUTION: Do not use the thumb
to lift the lower jaw.
CAUTION: Do not press deeply into the soft
tissue under the chin with the fingers as this could close the casualty’s airway.
CAUTION: Do not allow the casualty’s mouth to
close. The mouth must remain open so the casualty can breath air in and out.
b. Jaw Thrust Method.
(1) Kneel at the top of the casualty’s head.
(2) Rest your elbows on the surface where casualty is lying (ground, etc.).
(3) Place one hand on each side of the casualty’s lower jaw at the angle of the jaw, below the ears.
(4) Stabilize the casualty’s head with your forearms.
(5) Use the index fingers to push the angles of the patient’s lower jaw forward.
(6) Use the thumb to retract the patient’s lower lip to keep the casualty’s mouth open, if necessary. See figure 3-2.
CAUTION: Do not tilt or rotate the
casualty’s head.
CAUTION: Do not allow the casualty’s mouth to close. The mouth must
remain open so the casualty can breath air in and out.
Figure 3-2. Opening the airway using the jaw thrust method.
3-5. CHECKING THE CASUALTY FOR BREATHING
While maintaining the open airway position (head-tilt/neck-lift or jaw thrust), place your ear over the
casualty’s mouth and nose and look toward the chest and stomach (figure 3-3).
a. Look to see
if the casualty's chest rises and falls.
b. Listen for air escaping during
exhalation.
c. Feel for the flow of air on the
side of your face.
Figure 3-3. Checking for signs of breathing while maintaining an open airway.
d. Take appropriate action.
(1) If the casualty is not breathing, begin rescue breathing.
(2) If the casualty is breathing, count the number of respirations for 15 seconds. If the casualty is unconscious, or if his respiratory rate is less than two breaths in 15 seconds, and/or if the casualty is making snoring or gurgling sounds, insert a nasal airway (paragraph 3-6) and place the casualty in the recovery position (paragraph 3-7).
3-6. PERFORMING RESCUE BREATHING (MOUTH-TO-MOUTH)
Rescue breathing is performed when the casualty is not
breathing on his own. In rescue breathing, you use air from your own lungs
to inflate the casualty’s lungs. Keep the casualty on his back and maintain
the casualty's airway using the head-tilt/chin-lift or jaw thrust, as
appropriate.
NOTE: If you have
a face shield available, insert the shield into the casualty's mouth, with
the short airway portion over the top of the tongue and flatten the plastic
sheet around the mouth to cover the casualty's mouth, use it. The shield
acts as a barrier protecting the rescuer from secretions from the casualty's
mouth.
a. Close Casualty's Nose.
(1) If you are using the head-tilt/chin-lift, use the thumb and index finger of your hand on the casualty's forehead to gently pinch the casualty's nostrils closed while continuing to exert pressure on the casualty's forehead to maintain the backward head tilt position.
(2) If you are using the jaw thrust, close the casualty's nostrils by placing your cheek tightly against the nose.
b. Administer Two Full Breaths.
(1) Open your mouth wide and take a deep breath.
(2) Place your mouth over the casualty's mouth. Make sure that your mouth forms a good seal around the casualty's mouth so air will not escape when you blow air into the casualty's mouth. Make sure that the fingertips under the chin keep the jaw lifted. Maintaining the open airway will keep the casualty's mouth open slightly.
(3) Blow a breath into the casualty's mouth (figure 3-4). As you blow, observe the casualty's chest. If air is getting into the casualty's lungs, his chest will rise.
(4) After blowing the first breath, quickly take a deep breath, seal your mouth over the casualty's mouth again, and blow. Administering the two breaths (ventilations) should take about 3 to 4 seconds.
Figure 3-4. Administering mouth-to-mouth resuscitation.
(5) Break the seal over the casualty's mouth and release his nose. This will allow the casualty's body to exhale.
CAUTION: If you
cannot seal off the casualty's nose or if the casualty has injuries to his
mouth or jaw area that prevent you from administering mouth-to-mouth
resuscitation, administer mouth-to-nose resuscitation instead. Close the
casualty's mouth so air will not escape, seal your mouth over the casualty's
nose, and blow the two breaths (ventilations) into his nostrils. Rates for
mouth-to-nose respiration are the same as for mouth-to-mouth respirations.
c. Evaluate Effectiveness of the Ventilations.
(1) If the casualty begins breathing again on his own, look for injuries.
(2) If air goes in and out of the casualty's lungs (chest rises and falls) but he does not start breathing on his own, check his pulse.
(3) If the casualty's chest did not rise and fall, then air is not getting into his lungs.(a) Try to open the casualty's airway more (lift the chin more and/or increase the tilt of the head) and administer two full breaths again.
(b) If the casualty's chest still does not rise, a foreign object is probably blocking his airway. Remove any visible blockage. Administer manual thrusts (see Section II of this lesson) as needed to expel any blockage. Once the airway is unblocked and the obstruction removed, administer two full breaths again and reevaluate.
d. Check the Casualty's Pulse. If the casualty's airway is open (two full breaths delivered successfully), check for a pulse. A pulse indicates that the heart is still pumping blood.
(1) Continue to maintain the casualty's airway. If the head-tilt/chin-lift method is being used, keep one hand pressing on the casualty's forehead.
(2) Locate the carotid artery on the side of the casualty's neck that is closest to you. One carotid artery is located in the groove on the left side of the trachea (windpipe) next to the casualty's larynx (Adam's apple). The other carotid artery is located in the groove on the right side of the trachea next to the casualty's larynx.
(3) Once the artery is located, gently press on the artery with your middle and index fingers and feel for a pulse for 5 to 10 seconds (figure 3-5). Also look for signs of spontaneous breathing (rising and falling of the casualty's chest, etc.) while checking the pulse.
CAUTION: Do not use your thumb to feel for the casualty's pulse. If you use your thumb, you may mistake the pulse in your thumb for the casualty's pulse.
Figure 3-5. Feeling for a carotid pulse.
(4) Evaluate the situation and perform needed actions.(a) If the casualty resumes breathing on his own, check for injuries. Continue to monitor the casualty's breathing and be prepared to resume administering mouth-to-mouth resuscitation if needed.
(b) If the casualty has a pulse but is not breathing on his own, continue mouth-to-mouth resuscitation (paragraph e below).
(c) If the casualty has no pulse, administer cardiopulmonary resuscitation (CPR) (see Section III) if the combat situation allows and send a soldier to find medical help.
NOTE: In a
tactical situation, if a casualty is found with no pulse and no respiration,
CPR is not recommended.
e. Continue
Mouth-to-Mouth Resuscitation. If the casualty has an unobstructed
airway, a pulse, and is not breathing on his own, continue to administer
mouth-to-mouth resuscitation.
(1) Open the casualty's airway.
(2) Take a deep breath.
(3) Close the casualty's nostrils.
(4) Seal your mouth over the casualty's mouth.
(5) Blow the breath into the casualty's lungs. Observe the rising of the casualty's chest to ensure that the ventilation is effective.
(6) Break your seal over the casualty's mouth and release his nose. This will allow the casualty to exhale on his own.
(7) Repeat ventilations at the rate of one ventilation (breath) every 5 seconds).
(8) After about one minute, stop ventilations and check the carotid pulse again. Observe for spontaneous breathing (chest rising and falling) as you feel for the pulse. The procedure should take 3 to 5 seconds.(a) If the casualty resumes breathing on his own, check for injuries.(9) Continue administering mouth-to-mouth resuscitation and pulse checks until:
(b) If the casualty has a pulse but is not breathing on his own, continue administering mouth-to-mouth resuscitation. Continue to check his pulse and check for resumed spontaneous breathing every minute or so.
(c) If no pulse is found, perform CPR if the combat situation allows and send a soldier to seek medical help.(a) The casualty begins breathing on his own.
(b) You are relieved by a qualified person, such as the combat medic.
(c) You must seek medical help (no pulse).
(d) You must continue with your combat duties.
(e) You are too exhausted to continue.
3-7. INSERTING A NASOPHARYNGEAL AIRWAY
A nasopharyngeal airway (see figure 3-6) provides an open
(patent) airway and helps to keep the tongue from falling to the back of the
mouth and blocking the airway. Instructions for inserting a nasopharyngeal
airway are given below.
CAUTION: Do not use the nasopharyngeal airway if the roof of the
casualty's mouth is fractured or brain matter is exposed.
CAUTION: Do not use the
nasopharyngeal airway if there is clear fluid (cerebrospinal fluid [CSF])
coming from the ears or nose. This may indicate a skull fracture.
a. Place the
casualty on his back with his face up (see paragraph 2-5).
b. Lubricate
the tube with water or sterile lubricating jelly (figure 3-7).
c. Insert the
airway.
(1) Expose the opening of the casualty's nostril (figure 3-8).
NOTE: The casualty's right nostril is usually used.
(2) Insert the tip of the airway tube into the nostril.
(3) Position the tube so that the bevel (pointed end) of the airway faces toward the septum (the partition inside the nose that separates the nostrils).
(4) Insert the airway into the nostril and advance it until the flange rests against the nostril (figures 3-9 and 3-10).
Figure 3-6. Example of a nasopharyngeal airway and package.
Figure 3-7. Lubricating the nasopharyngeal airway tube with sterile lubricating jelly.
Figure 3-8. Exposing the opening of the casualty's nostril.
Figure 3-9. Cut-away showing nasopharyngeal airway
keeping the tongue from blocking the trachea (windpipe).
Figure 3-10. Airway inserted with flange resting against the nostril.
CAUTION:
Never force the airway into the casualty’s nostril. If
resistance is met, pull the tube out and attempt to insert it in the other
nostril. If neither nostril will accommodate the airway, go to step d.
d. Place the
casualty in the recovery position (paragraph 3-8).
e. Send a
soldier to seek medical aid or seek medical aid for the casualty yourself.
3-8. PLACING THE CASUALTY IN A RECOVERY POSITION
The recovery position (figure 3-11) allows blood and mucus
to drain out of the casualty’s nose and mouth and not to drain back into the
airway. To place a casualty in the recovery position:
a. Roll the
casualty as a single unit onto his side.
b. Place the
hand of the casualty's lower arm under his chin.
c. Flex the
casualty's upper leg.
Figure 3-11. Casualty in the recovery position.
3-9. MONITORING THE CASUALTY'S BREATHING
Continue to monitor the casualty's breathing.
a. If the
casualty does not have a nasopharyngeal airway inserted and his breathing
rate falls below two breaths every 15 seconds, insert a nasopharyngeal
airway.
b. If tension
pneumothorax develops, perform a needle chest decompression (Lesson 4).
c. If needed,
prepare the casualty for evacuation (Lesson 7).
Section Il. REMOVING AN OBSTRUCTION FROM A PERSON'S AIRWAY
NOTE: This
material is placed in a separate section because it will seldom be used on
the battlefield. Although the manual thrusts may be used to remove airway
blockage in an unconscious casualty, they are normally used in a on-combat
setting.
3-10. INTRODUCTION
a. An upper
airway obstruction (blockage) occurs when an object enters a person's
trachea (windpipe) and obstructs airflow. The blockage can be caused by
food, blood clots or loose teeth resulting from a head injury, vomitus
(regurgitated stomach contents) which has been inhaled, or objects such as
buttons. The blockage must be expelled or removed and breathing restored. A
blockage that stops breathing or greatly reduces the amount of air that can
be inhaled and exhaled can quickly lead to unconsciousness and death.
b. A person
with an airway obstruction will automatically begin to cough or at least try
to cough. In addition, he will probably clutch his throat. This clutching
action is natural, but it has also been adopted as the universal distress
signal for choking figure 3-12). This sign alerts other people that the
problem is an airway obstruction rather than another problem such as a heart
attack.
Figure 3-12. Universal distress signal for choking
3-11. EVALUATING THE BLOCKAGE
a.
Partial Blockage With Good Air Exchange. If the person can speak or
cough forcefully, he has a partial blockage with good air exchange. (A
partial blockage means that the airway is not completely blocked and air can
still get to and from the person's lungs. Good air exchange indicates that
the person can still inhale and exhale enough air to carry on all life
processes.) A person may have good air exchange even though he makes a
high-pitched sound between coughs. Encourage a person with good air exchange
to keep coughing until the obstruction is coughed up. Do not
interfere with his efforts. Do not leave the person since "good" air
exchange can rapidly deteriorate to "poor" air exchange or complete
blockage, either of which can result in unconsciousness and death. Be
prepared to administer manual thrusts should his condition worsen.
b. Partial
Blockage With Poor Air Exchange. If the person has a weak cough, makes
high-pitched noises (like crowing) while inhaling, or has a bluish tint
around his lips and fingernail beds, he has a partial blockage with poor air
exchange. A person with poor air exchange is not inhaling enough air to
continue carrying on all life processes. If the person is not helped, he
will become unconscious and die. If a person has poor air exchange, call for
help and begin administering manual thrusts. If possible, send someone to
seek medical help.
CAUTION:
If you cannot decide whether a conscious person has good or
poor air exchange, tell him to speak to you. If he does not speak, assume he
has an obstructed airway.
c. Complete
Blockage. If the person's airway is completely blocked, he can neither
inhale nor exhale (no air exchange occurring). This means he cannot speak at
all. Quick action is needed to clear the airway. Call for help and begin
administering manual thrusts. If possible, send someone to seek medical
help.
CAUTION:
Do not slap a choking person on his back. Blows to his back
may cause the object to go down the airway instead of out of the airway.
NOTE: A manual thrust acts like an artificial
cough. Each thrust is performed with the intent of dislodging the
obstruction without having to perform additional thrusts.
3-12. ADMINISTERING ABDOMINAL THRUSTS TO A CONSCIOUS PERSON
NOTE: This
procedure can be performed on a person who is standing or sitting.
CAUTION: If the
person has significant abdominal injuries, is noticeably pregnant, or has a
waist that is too large to encircle, administer chest thrusts instead of
abdominal thrusts.
a. Stand behind the person, insert your arms under his
arms, and wrap your arms around his waist.
b. Make a fist with one hand and place the thumb side of
your fist on the midline of the person's abdomen slightly above his navel
(belt buckle) and well below the bottom tip of his breastbone (xyphoid
process).
c. Grasp your fist with your other hand.
d. Press your fists into the person's abdomen using a
quick inward and upward motion (figure 3-13), then relax the hold.
e. Continue administering abdominal thrusts at a rate of
one thrust every 4 or 5 seconds until the obstruction is expelled or the
person becomes unconscious. Each thrust should be a separate and distinct
movement delivered with the intent of dislodging and expelling the object
causing the blockage.
f. If the person loses consciousness before the object is
expelled, call for help again, move backward, and lower the person onto the
ground so that he is in a supine (on his back) position.
Figure 3-13. Administering an abdominal thrust to a standing person.
3-13. ADMINISTER CHEST THRUSTS TO A CONSCIOUS PERSON
a. Stand behind
the person, place your arms under his armpits, and encircle his chest.
b. Make a fist
with one hand and place the thumb side of the fist on the middle of
the person's breastbone (sternum).
WARNING: A thrust delivered directly to the ribs or to the bottom of the
sternum can fracture the ribs or the xiphoid process (a small bone
at the bottom of the sternum) which could puncture internal organs such as the lungs and heart.
c. Cover your
fist with your other hand.
d. Thrust
inward (figure 3-14) so the sternum is depressed about 1 1/2 to 2 inches,
then relax the hold.
Figure 3-14. Administering a chest thrust to a standing person.
e. Continue
administering chest thrusts at a rate of one thrust every 4 or 5 seconds
until the obstruction is expelled or the person becomes unconscious. Each
thrust should be a separate and distinct movement delivered with the intent
of dislodging and expelling the object causing the blockage.
f. If the
casualty loses consciousness before the object is expelled, call for help
again, move backward, and lower the casualty onto the ground so that he is
in a supine (on his back) position.
3-14. PREPARING TO ADMINISTER THRUSTS TO AN UNCONSCIOUS PERSON
a. Position the
person so that he is lying flat on his back on a solid surface (for example,
the ground rather than on a mattress.)
b. Open the
person's mouth by grasping the lower teeth, and using the thumb and index
finger to lift the jaw open.
c. Look into
the mouth and perform a finger sweep to locate and remove any loose
obstruction. Do this by inserting the index finger of your hand along the
inside of one cheek. Using a hooking motion, move your finger from the far
side of the mouth to the near side.
d. Open the
person's airway and administer two breaths using the procedures given in
paragraphs 3-4 and 3-6. If the attempt fails, reposition the head to further
open the airway and try again.
(1) If you see the chest rise and fall, check the person’s pulse. If the person has a pulse, perform mouth-to-mouth rescue breathing. If there is no pulse, perform cardiopulmonary resuscitation.
(2) If the attempts at ventilation fail, perform abdominal or chest thrusts for an unconscious person. If the person has significant abdominal injuries, is noticeably pregnant, or is extremely overweight, administer chest thrusts. Otherwise, administer abdominal thrusts.
3-15. ADMINISTERING ABDOMINAL THRUSTS TO AN UNCONSCIOUS PERSON
a. Kneel
astride the person's thighs.
b. Place the
heel of one hand on the midline of the person's abdomen slightly above the
navel (belt buckle) and well below the tip of the breastbone (xiphoid
process) with the fingers pointing toward the person's head (figure 3-15).
Do not make your hand into a fist.
Figure 3-15. Administering an abdominal thrust to an unconscious person.
c. Place your
other hand on top of the first hand.
d. Press into
the abdomen using a quick forward (inward) and upward thrust. The thrust can
be delivered by locking your elbows and shifting your body weight forward.
e. Release the
pressure on the person's abdomen (shift your body weight backward).
(1) If you think the obstruction has been dislodged, perform a finger sweep and administer two full breaths. If the airway is open, check for a pulse and for spontaneous breathing (person breathing on his own).
(2) If the obstruction was not dislodged, administer another abdominal thrust. If you administer five abdominal thrusts without dislodging the obstruction, call for help again, perform a finger sweep, and try to administer two breaths. Repeat the cycle of five abdominal thrusts, finger sweep, and breaths until the object is expelled and the person's airway is open (chest rises during ventilations).
CAUTION:
If the person vomits, turn him onto his side and use a
quick finger sweep to remove vomitus from his mouth.
3-16. ADMINISTERING CHEST THRUSTS TO AN UNCONSCIOUS PERSON
a. Kneel close
beside the person's chest.
b. Locate the
lower edge of the person's rib cage (figure 3-16 A).
c. Run the
fingers of your hand nearest the person's feet along the lower edge of the
rib cage until you come to the notch where the rib meets the breastbone.
d. Place your
middle finger (same hand) on the notch with your index finger just above it.
Your index finger will be resting on the lower end of the breastbone (figure
3-16 B).
e. Place the
heel of your other hand on the lower half of the breastbone next to and
above (toward the person's head) your two fingers (figure 3-16 C). Do not
form a fist. The heel of this hand is on the compression site (lower half of
the sternum and above the xiphoid process). Using this compression site
avoids pressing on the tip of the breastbone, which could result in further
injury.
CAUTION:
Make sure the heel of your hand is on the breastbone and is
not resting on the ribs.
Figure 3-16. Locating the compression site for chest thrusts.
f. Remove your
fingers from the notch area and place that hand on top of the hand on the
compression site. Either extend or interlace your fingers.
g. Straighten
your arms and lock your elbows. Position your shoulders directly above your
hands.
h. Without
bending your elbows, rocking, or allowing your shoulders to sag, apply
enough pressure straight down to depress the person's breastbone 1½ to 2
inches (figure 3-17).
Figure 3-17. Administering a chest thrust to an unconscious person.
i. Release the pressure on the person's chest (shift your body weight backward).
(1) If you think the obstruction has been dislodged, perform a finger sweep and administer two full breaths. If the airway is open, check for a pulse and for spontaneous breathing (person breathing on his own).
(2) If the obstruction was not dislodged, administer another chest thrust. If you administer five chest thrusts without dislodging the obstruction, call for help again, perform a finger sweep, and try to administer two breaths. Repeat the cycle of five chest thrusts, finger sweep, and breaths until the object is expelled and the person's airway is open (chest rises during ventilations).
CAUTION: If the person vomits, turn him onto his side and use a quick finger sweep to remove vomitus from his mouth.
Section III. PERFORMING CARDIOPULMONARY RESUSCITATION
3-17. CARDIOPULMONARY RESUSCITATION
Cardiopulmonary resuscitation (CPR) allows the rescuer to
cause the person's heart to pump blood and his lungs to process oxygen.
Cardiopulmonary resuscitation is seldom used in combat. It is primarily used
in everyday life when a person has a heart attack and falls unconscious.
3-18. PRELIMINARY MEASURES
The following are performed when you find a person before
beginning CPR. If you have already performed these measures (previous
sections), do not repeat them.
a. Check for
Responsiveness. Ask in a loud, but calm voice, "Are you okay?’ Gently
shake or tap the person on the shoulder. If the person does not respond,
position the person on his back and send someone to get medical help.
b. Open the
Airway. Open the person's airway using the head-tilt/chin-lift or the
jaw thrust, as appropriate. If a spinal injury is suspected, use the
jaw-thrust method.
c. Check for
Breathing. Place your ear an inch above the person’s mouth and look,
listen, and feel for breathing.
d.
Administer Two Full Breaths. If the person is not breathing, administer
two full ventilations. If the ventilations are not successful (chest does
not rise and fall), reposition the person's head to increase the airway and
administer two more breaths. If the second attempt fails, perform abdominal
or chest thrusts to remove the blockage.
e. Check
Pulse. Once the airway is open and breaths have been administered, check
the person's pulse. If there is a pulse, continue rescue breathing efforts.
If there is no pulse, perform cardiopulmonary resuscitation.
3-19. CARDIOPULMONARY RESUSCITATION
Once you have determined that the person has no pulse, CPR
is required.
a. Perform
Chest Compressions.
(1) Place the person on a hard, flat surface.
(2) Locate the compression site using the same methods as locating the compression site for chest thrusts on an unconscious person.
(3) Perform a CPR compression using the same procedures as for delivering a chest thrust to an unconscious person.
(4) Administer 15 compressions in 9 to 11 seconds (a rate of about 100 per minute).
NOTE: Do not remove the heel of your hand from the person’s chest or reposition your hand between compressions.
b. Perform
Ventilations. Open the person's airway and administer two full breaths.
(1.5 to 2 seconds each).
c. Repeat
Compressions-Ventilations Cycle. Repeat steps a and b for a total of
four complete cycles.
d. Check the
Pulse. After four cycles (about one minute), check the person's carotid
pulse for 3 to 5 seconds.
(1) If a pulse is present, perform rescue breathing.
(2) If a pulse is not present, continue to perform CPR. Continue performing cycles consisting of 15 compressions and 2 ventilations at a rate of four cycles per minute (60 compressions, 8 breaths per minute). Recheck the person's pulse every 3 to 5 minutes. Continue performing CPR until the person’s pulse returns, you are relieved by a qualified person, your are told to stop by a physician or a superior, or you are too tired to continue.
LESSON EXERCISES: LESSON 3
INSTRUCTIONS: Answer the following exercises by
marking the letter of the response that best answers the question or
best completes the sentence or by writing the answer in the space
provided.
After you have answered all of the exercises, check your
answers against the "Solutions to Lesson Exercises" at the end of the
exercises. For each exercise answered incorrectly, reread the lesson
material referenced.
1. You find a soldier who appears to be unconscious. Which of the following should be your first action in rendering aid to this person?
a. Check his pulse.
b. Call out "Are you okay?" and gently shake his shoulder.
c. Begin inserting a nasopharyngeal airway.
d. Open his airway.
e. Begin performing mouth-to mouth resuscitation.
2. You are going to check the casualty to see if he is breathing. How should you position the casualty?
a. On his back.
b. On his stomach.
c. On his right side.
d. On his left side.
3. Which method of opening the airway is preferred if you believe that the casualty has an injured neck or spine?
a. Head-tilt/chin-lift.
b. Jaw thrust.
4. In the head-tilt/chin-lift method of opening a casualty's airway, one hand is used to press on his forehead. How is the thumb on the opposite hand used?
a. Lift the casualty's chin by hooking the thumb under the casualty's jaw.
b. Hook over the casualty's bottom teeth to ensure a good grip on his chin.
c. Press against the casualty's nose to seal off his nostrils.
d. Keep the casualty's lower lip depressed, if needed.
5. When performing the head-tilt/chin-lift method of
opening a casualty's airway, you __________ allow your fingers to press
deeply in the soft tissues under the chin.
a. Should.
b. Should not.
6. When performing a jaw thrust on a casualty lying on the
ground, your elbows should be resting on the:
a. Casualty's chest.
b. Casualty's abdomen.
c. Ground.
7. When turning a casualty, one of your hands is used to support the casualty's head and neck. What should you do with the other hand.
a. Reach across the casualty's chest, grab under the casualty's arm, and pull the casualty toward you.
b. Place your hand under the casualty's side that is nearest to you and push the casualty away from you.
8. When you check for breathing, you should:
a. Watch the casualty's chest to see if it rises and falls.
b. Listen for sounds of breathing.
c. Feel for any exhaled breath blowing against your face.
d. All of the above.
9. What are three indicators that a nasopharyngeal airway
should be inserted?
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
10. What should you do with the nasopharyngeal tube before
inserting it into the casualty's nostril?
a. Lubricate the outside of the tube with antibacterial ointment.
b. Rub the outside of the tube with an iodine solution.
c. Pour alcohol through the inside of the tube.
d. Lubricate the outside of the tube with water or sterile lubricating jelly.
e. None of the above; the tube is inserted as is.
11. Normally, the nasopharyngeal tube is inserted into the casualty's _______ nostril.
a. Left.
b. Right.
12. You are inserting a nasopharyngeal tube into the casualty's nostril when resistance is met. What should you do?
a. Continue inserting the tube.
b. Begin twisting the tube so that it slides around the blockage.
c. Remove the tube and insert it into the nostril again.
d. Remove the tube and insert it into the other nostril.
e. Remove the tube and begin cardiopulmonary resuscitation.
13. Upon successfully inserting a nasopharyngeal airway, the flange of the airway should be:
a. Inserted as far as possible into the casualty's nostril.
b. Against the outer part of the casualty's nostril.
c. About half an inch from the outside of the casualty's nostril.
d. About an inch from the outside of the casualty's nostril.
14. You have inserted a nasopharyngeal airway. How should you position the casualty?
a. On his back.
b. On his stomach.
c. On his side.
15. You are going to perform mouth-to-mouth rescue
breathing while maintaining an open airway using the head-tilt/chin-lift.
You should seal the casualty's nostrils by
________________________________________________________________
________________________________________________________________
16. You are beginning to administer rescue breathing. You should begin by:
a. Administering one full breath.
b. Administering two full breaths.
c. Administering five full breaths.
d. Administering 15 quick breaths.
17. After administering the initial ventilation(s) in rescue breathing and determining that the chest rises and falls, you should:
a. Begin CPR.
b. Continue administering ventilations.
c. Check for a pulse.
d. Go to seek medical help.
18. Once rescue breathing has been initiated, ventilations should be administered at a rate of :
a. One breath every 5 seconds.
b. Two breaths every 3-4 seconds.
c. Five breaths every minute.
d. Fifteen breaths every 9-10 seconds.
19. You are administering cardiopulmonary resuscitation to a casualty on the battlefield. Your squad leader tells you that you must move out and to stop performing CPR. You feel that you can still continue your CPR efforts. What should you do?
a. Continue administering CPR.
b. Ask your squad leader to obtain a medical opinion from a physician.
c. Follow you squad leader's instructions.
20. You walk into a room. The only other person in the room has a scared look on his face. He quickly places his hand around the front part of his throat, but does not say anything. What is probably happening?
a. The person is feeling faint.
b. The person is having a heart attack.
c. The person is choking.
d. The person is in shock.
21. Before giving manual thrusts to a choking person, you should:
a. Determine if the person has good, poor, or no air exchange.
b. Check the person's pulse.
c. Slap the person on his back.
d. Have the person lie down and elevate his feet.
22. If the person with an obstruction can speak or cough
forcefully, you should:
a. Begin administering manual thrusts.
b. Begin slapping the person on the back.
c. Have the person lie down before be becomes unconscious.
d. Encourage the person to keep coughing.
23. You are going to administer manual thrusts to a person
who is choking. When is the chest thrust used rather than the abdominal
thrust?
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
24. An abdominal thrust is delivered using a:
a. Quick inward and downward motion.
b. Slow inward and downward motion.
c. Quick inward and upward motion.
d. Slow inward and upward motion.
25. When performing an abdominal thrust, your fist should
be
____________________________________________________________________________________.
26. When performing a chest thrust to a person who is standing, your fist should be
_________________________________________________________________.
27. When trying to dislodge an object from a standing
person's airway, manual thrusts should be delivered every _____
to_____ seconds until the object is expelled or the casualty
________________________________________.
28. When trying to expel an airway obstruction in an
unconscious person using chest thrust, the person's sternum should be
depressed about ______________ .
29. Before performing CPR on a person, you should make
sure:
a. The person does not have a pulse.
b. The person is not breathing on his own.
c. The person's airway is open.
d. a and b above.
e. a, b, and c above.
30. When performing chest compressions during CPR, the
compression site should be:
______________________________________________________________.
31. When performing chest compressions during CPR the
person's sternum should be depressed about ______________________
inches.
32. While performing CPR, you should administer
______
compression(s) followed by ______ ventilations. These cycles are performed
at the rate of ________ cycle(s) per minute.
33. If possible, form a group of three. One person plays
the role of the casualty, the second plays the role of the rescuer, and the
third plays the role of the evaluator (the evaluator uses this lesson as a
guide). Practice the following:
a. Turning the casualty from his front onto his back
b. Performing the head-tilt/chin-lift.
c. Performing the jaw thrust.
34. If you have access to an appropriate manikin, practice inserting the following:
a. Performing rescue breathing.
b. Performing abdominal thrusts (standing casualty).
c. Performing cardiopulmonary resuscitation.
35. If you have access to an appropriate manikin and a nasopharyngeal airway, practice inserting the airway.
SOLUTIONS TO LESSON EXERCISES: LESSON 3 (Scroll Down)
1. b (para 3-2)
2. a (para 3-3)
3. b (para 3-4)
4. d (para 3-4a(4))
5. b (para 3-4a(4) Second caution)
6. c (para 3-4b(2))
7. a (paras 3-3; 2-5e, f, g)
8. d (paras 3-5a, b, c)
9. Casualty is unconscious
Casualty's respiration rate is less than 2 breaths every 15 seconds.
Casualty is making snoring or gurgling sounds. (para 3-5d(2))
10. d (para 3-7b)
11. b (para 3-7c(1) Note)
12. d (para 3-7c(4) Caution)
13. b (para 3-7c(4)
14. c (paras 3-5d(2), 3-7d, 3-8a)
15. Pinching the nostrils with the thumb and index finger of the hand
exerting pressure to the casualty's forehead. (para 3-6a(1).
16. b (para 3-6b)
17. c (para 3-6d)
18. a (para 3-6e(7)
19. c (para 3-19d(2)
20. c (para 3-10b, fig 3-12)
21. a (paras 3-11a, b, c)
22. d (para 3-11a)
23. The person has significant abdominal injuries. The person is
noticeably pregnant. The person's waist that is too large to encircle with
your arms. (para 3-12 Caution)
24. c (para 3-12d)
25. Slightly above the person's navel. (paras 3-12b, 3-15b)
26. Over the middle of the person's breastbone (sternum) (para 3-13b)
27. 4 to 5 second; looses consciousness. (paras 3-12e, 3-13e)
28. One and a half to two inches. (para 3-16h)
29. e (paras 3-18b, c, d, e)
30. On the lower half of sternum and above the xyphoid process. (paras
3-19a(2), 3-16e)
31. One and a half to two. (paras 3-19a(3), 3-16h)
32. 15 (compressions), 2 (ventilations), 4 (cycles per minute) (paras
3-19d, d(2))
33. See the following checklists.
34. See the following checklists.
35. See the last checklist.
|
CHECK AND TURN A CASUALTY Given: Simulated unconscious casualty lying on his stomach |
||
| GO NO-GO | ||
| 1. | Checks the casualty for responsiveness (shakes or taps shoulder, asks "Are you OK?"). | ______ ______ |
| 2. | Kneels beside the casualty. | ______ ______ |
| 3. | Raises the casualty's near arm above his head. | ______ ______ |
| 4. | Straightens the casualty's legs. | ______ ______ |
| 5. | Supports the casualty's head and neck with one hand. | ______ ______ |
| 6. | Reaches across casualty with free hand, grabs casualty, and rolls casualty toward him in a steady and even manner. | ______ ______ |
| 7. | Places the casualty's arms at his side. | ______ ______ |
| OVERALL EVALUATION (A no-go on any step will result in a no-go for the entire task) |
GO NO-GO | |
|
PERFORM A HEAD-TILT/CHIN LIFT Given: Simulated unconscious casualty lying on his back with arms at his sides |
||
| GO NO-GO | ||
| 1. | Kneels at the casualty's shoulder. | ______ ______ |
| 2. | Places one hand on the casualty's forehead and applies firm pressure with the palm to tilt the head back. | ______ ______ |
| 3. | Places fingertips of other hand under the casualty's chin and lifts the lower jaw forward. | ______ ______ |
| 4. | Pressure from fingers do not interfere with casualty's airway. | ______ ______ |
| 5. | Casualty's upper and lower teeth are almost brought together, but the casualty's mouth is not closed. (The thumb on the hand performing the chin lift can be used to depress the casualty's lower lip if needed.) | ______ ______ |
| 6. | Checks casualty for breathing (looks for rising/falling chest, listens and feels for air flow). | ______ ______ |
| OVERALL EVALUATION (A no-go on any step will result in a no-go for the entire task) |
GO NO-GO | |
|
PERFORM A JAW THRUST Given: Simulated unconscious casualty lying on his back with arms at his sides |
||
| GO NO-GO | ||
| 1. | Kneels at the top of the casualty's head. | ______ ______ |
| 2. | Rests elbows on surface (ground, etc.). | ______ ______ |
| 3. | Places one hand on each side of casualty's head and stabilizes the casualty's head with his forearms. | ______ ______ |
| 4. | Places hands at the angles of the casualty's lower jaw. | ______ ______ |
| 5. | Pushes the angles of the lower jaw forward using his index fingers. | ______ ______ |
| 6. | Casualty's upper and lower teeth are almost brought together, but the casualty's mouth is not closed. (The thumb on the hand performing the chin lift can be used to depress the casualty's lower lip if needed.) | ______ ______ |
| 7. | Checks casualty for breathing (looks for rising/falling chest, listens and feels for air flow). | ______ ______ |
| OVERALL EVALUATION (A no-go on any step will result in a no-go for the entire task) |
GO NO-GO | |
|
PERFORM RESCUE BREATHING Given: Simulated unconscious casualty lying on his back with arms at his sides |
||
| GO NO-GO | ||
| 1. | Opens the casualty's airway. | ______ ______ |
| 2. | Closes the casualty's nostrils. | ______ ______ |
| 3. | Administers two full breaths. (Forms seal with mouth when performing ventilations; ventilations completed in 3-4 seconds.) | ______ ______ |
| 4. | If ventilations were not successful, opens casualty's airway more and tries again. | ______ ______ |
| 5. | Checks casualty's carotid pulse (artery on side of neck next to Adam's apple) for 5-10 seconds. | ______ ______ |
| 6. | Continues administering breaths at the rate of one ventilation every 5 seconds. | ______ ______ |
| 7. | Stops administering ventilations to check pulse about every minute. | ______ ______ |
| OVERALL EVALUATION (A no-go on any step will result in a no-go for the entire task) |
GO NO-GO | |
|
ADMINISTER ABDOMINAL THRUSTS TO A STANDING PERSON Given: Conscious standing person with simulated airway obstruction. |
||
| GO NO-GO | ||
| 1. | Verifies the person has poor or no air exchange (casualty cannot speak, etc.). | ______ ______ |
| 2. | Stands behind person and wraps arms around the person's waist. Person's arms are not trapped inside rescuer's arms. | ______ ______ |
| 3. | Makes a fist and places it slightly above the person's navel with the thumb side toward the person. | ______ ______ |
| 4. | Covers the fist with the other hand. | ______ ______ |
| 5. | Presses fist into abdomen with a quick inward, upward motion. | ______ ______ |
| 6. | Continues administering abdominal thrusts at a rate of about one thrust every 4-5 seconds until the blockage is expelled or the casualty becomes unconscious. | ______ ______ |
| OVERALL EVALUATION (A no-go on any step will result in a no-go for the entire task) |
GO NO-GO | |
|
ADMINISTER CARDIOPULMONARY RESUSCITATION Given: Simulated unconscious casualty with no respiration and no pulse lying on his back on the ground with arms at his sides. |
||
| GO NO-GO | ||
| 1. | Kneels close to the casualty's chest. | ______ ______ |
| 2. | Locates the compression site (runs middle finger along lower edge of rib cage to the notch at breastbone, places index finger above middle finger, places heel of other hand next to the index finger) on lower half of breastbone. | ______ ______ |
| 3. | Removes first hand and places it on top of hand at compression site. | ______ ______ |
| 4. | Extends or interlaces fingers of both hands. | ______ ______ |
| 5. | Straightens arms, locks elbows, and positions shoulders directly above hands (compression site). | ______ ______ |
| 6. | Presses straight down to depress the breastbone 1.5 to 2 inches. Elbows did not bend, shoulders did not sag, and casualty did not rock. | ______ ______ |
| 7. | Releases pressure to allow breastbone to rise. | ______ ______ |
| 8. | Performs a total of 15 chest compressions in 9-11 seconds without removing heel of hand from compression site. | ______ ______ |
| 9. | Opens the casualty's airway using head-tilt/chin-lift or jaw thrust, as appropriate. | ______ ______ |
| 10. | Administers two quick full breaths (3-4 seconds) | ______ ______ |
| 11. | Repeats 15 compressions-2 breaths cycle for a total of four cycles (about one minute) | ______ ______ |
| 12. | Checks carotid pulse for 3-5 seconds. | ______ ______ |
| 13. | If no pulse, continues 15 compressions-2 breaths cycles, rechecking the pulse every 3-5 minutes. | ______ ______ |
| OVERALL EVALUATION (A no-go on any step will result in a no-go for the entire task) |
GO NO-GO | |
|
INSERT A NASOPHARYNGEAL AIRWAY Given: Simulated unconscious casualty lying on his back with arms at his sides Nasopharyngeal airway (from combat lifesaver MES) Packet of sterile lubricating jelly (from combat lifesaver MES) |
||
| GO NO-GO | ||
| 1. | Positions casualty in a face up position. | ______ ______ |
| 2. | Lubricates the tube with provided jelly. | ______ ______ |
| 3. | Exposes the opening of the casualty's right nostril. | ______ ______ |
| 4. | Inserts the tip of the airway into the nostril with the bevel toward the septum. | ______ ______ |
| 5. | Advances airway until the flange rests against the nostril. | ______ ______ |
| 6. | Does not force the airway into the nostril. If resistance is met, pulls out the tube and attempts to insert it in the other nostril. | ______ ______ |
| 7. | Places the casualty in the recovery position (on his side with hand under his chin and upper leg flexed to stabilize the casualty. | ______ ______ |
| OVERALL EVALUATION (A no-go on any step will result in a no-go for the entire task) |
GO NO-GO | |
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